Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan
Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sind, Pakistan.
BMJ Paediatr Open. 2024 Jun 6;8(1):e002344. doi: 10.1136/bmjpo-2023-002344.
Knowledge about multisystem inflammatory syndrome in children (MIS-C) is evolving, and evidence-based standardised diagnostic and management protocols are lacking. Our review aims to summarise the clinical and diagnostic features, management strategies and outcomes of MIS-C and evaluate the variances in disease parameters and outcomes between high-income countries (HIC) and middle-income countries (MIC).
We searched four databases from December 2019 to March 2023. Observational studies with a sample size of 10 or more patients were included. Mean and prevalence ratios for various variables were pooled by random effects model using R. A mixed generalised linear model was employed to account for the heterogeneity, and publication bias was assessed via funnel and Doi plots. The primary outcome was pooled mean mortality among patients with MIS-C. Subgroup analysis was conducted based on the income status of the country of study.
A total of 120 studies (20 881 cases) were included in the review. The most common clinical presentations were fever (99%; 95% CI 99.6% to 100%), gastrointestinal symptoms (76.7%; 95% CI 73.1% to 79.9%) and dermatological symptoms (63.3%; 95% CI 58.7% to 67.7%). Laboratory investigations suggested raised inflammatory, coagulation and cardiac markers. The most common management strategies were intravenous immunoglobulins (87.5%; 95% CI 82.9% to 91%) and steroids (74.7%; 95% CI 68.7% to 79.9%). Around 53.1% (95% CI 47.3% to 58.9%) required paediatric intensive care unit admissions, and overall mortality was 3.9% (95% CI 2.7% to 5.6%). Patients in MIC were younger, had a higher frequency of respiratory distress and evidence of cardiac dysfunction, with a longer hospital and intensive care unit stay and had a higher mortality rate than patients in HIC.
MIS-C is a severe multisystem disease with better mortality outcomes in HIC as compared with MIC. The findings emphasise the need for standardised protocols and further research to optimise patient care and address disparities between HIC and MIC.
CRD42020195823.
儿童多系统炎症综合征（MIS-C）的相关知识仍在不断发展，目前缺乏基于循证的标准化诊断和管理方案。我们的综述旨在总结 MIS-C 的临床和诊断特征、管理策略和结局，并评估高收入国家（HIC）和中等收入国家（MIC）之间疾病参数和结局的差异。
我们于 2019 年 12 月至 2023 年 3 月检索了四个数据库。纳入样本量为 10 例或以上的观察性研究。使用 R 软件通过随机效应模型对各种变量的平均值和患病率比进行汇总。采用混合广义线性模型来解释异质性，并通过漏斗图和 Doi 图评估发表偏倚。主要结局是 MIS-C 患者的汇总死亡率。根据研究国家的收入状况进行亚组分析。
综述共纳入 120 项研究（20881 例）。最常见的临床表现为发热（99%；95%CI 99.6%至 100%）、胃肠道症状（76.7%；95%CI 73.1%至 79.9%）和皮肤症状（63.3%；95%CI 58.7%至 67.7%）。实验室检查提示炎症、凝血和心脏标志物升高。最常见的治疗策略是静脉注射免疫球蛋白（87.5%；95%CI 82.9%至 91%）和类固醇（74.7%；95%CI 68.7%至 79.9%）。约 53.1%（95%CI 47.3%至 58.9%）需要入住儿科重症监护病房，总体死亡率为 3.9%（95%CI 2.7%至 5.6%）。MIC 组患者年龄较小，呼吸窘迫发生率较高，且有心脏功能障碍证据，住院和重症监护病房停留时间较长，死亡率高于 HIC 组。
MIS-C 是一种严重的多系统疾病，HIC 的死亡率优于 MIC。这些发现强调需要制定标准化方案，并开展进一步研究，以优化患者的治疗效果，并解决 HIC 和 MIC 之间的差异。
PROSPERO 注册号：CRD42020195823。
